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Rib Fractures

by Thomas G. Weiser, MD, MPH

  • Rib fractures cause severe pain, particularly when a person breathes deeply.

  • A chest x-ray is usually taken.

  • People are given pain relievers and are asked to cough or breathe deeply about once an hour to prevent lung problems.

Rib fractures usually result from strong blunt force, such as a fall from a height, a motor vehicle crash, or a hit with a baseball bat. However, sometimes in older people who have osteoporosis, only a slight force (as occurs in a minor fall) is required.

The fracture itself is rarely serious, although the force that caused the fracture occasionally causes other problems, such as a bruised lung (pulmonary contusion—see Pulmonary Contusion) or a collapsed lung (pneumothorax—see Traumatic Pneumothorax). An injury that fractures the lower ribs sometimes also damages the liver (see Liver Injury) or spleen (see Spleen Injury). The more ribs that are broken, the more likely lungs or other organs are to be damaged.

Flail chest can result if several adjacent ribs are broken in more than one place. In flail chest, a segment of the chest wall separates from the rest and moves in the opposite direction from the rest of the chest wall when a person breathes. Breathing becomes more difficult and tiring. Usually, a blow strong enough to cause flail chest also bruises the lung beneath the injured area (see Pulmonary Contusion).

Symptoms

Rib fractures cause severe pain, particularly when people breathe deeply. The pain lasts for weeks.

Because of the pain, people may breathe less deeply, increasing the risk of complications, such as collapse of parts of the lung (atelectasis—see Atelectasis) and pneumonia (see Overview of Pneumonia). Complications are more likely to occur in

  • Older people

  • People with several rib fractures

Because older people are more likely to develop these complications, they also have a higher risk of death due to a rib fracture than do younger people.

Diagnosis

  • A doctor's evaluation

Doctors suspect rib fracture when one or more ribs are very tender in one particular spot. Sometimes doctors can feel the broken ribs when they gently push the injured area. Doctors do not always need to confirm rib fractures with an x-ray because the presence of rib fractures does not change the way a chest injury is treated. Nonetheless, doctors usually do a chest x-ray to detect serious problems that can accompany rib fractures, such as a bruised or collapsed lung. Not all rib fractures can be seen on a chest x-ray.

Did You Know...

  • Diagnosis of rib fractures by x-rays is unnecessary.

Treatment

  • Pain relievers

  • Coughing and deep breathing

Regardless of whether rib fractures are identified, people are given pain relievers (analgesics). Those with severe pain are usually given opioid pain relievers such as oxycodone or hydrocodone. Sometimes hospitalized people who have severe pain are treated by numbing the nerve to the affected ribs or with injection of drugs around the spinal cord (epidural analgesia).

People with a rib fracture are asked to cough or breathe deeply about once an hour while they are awake to keep the air sacs in the lung open and prevent pneumonia.

People with several rib fractures may need to be treated in the hospital.

People with flail chest often need to have their breathing supported with a ventilator until the injuries heal.

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  • OXYCONTIN